Panel discussion: Medical ethics (video)

On November 6, 2013, Malaysia’s largest private healthcare provider KPJ Healthcare hosted its annual medical convention in Kuala Lumpur. For the first time in the 12 years of the tenure of this convention, KPJ decided that it will open some of the debates that would traditionally revolve around medicine and clinical practices to the larger issues that affect the morality of doing business in any industry, not least the medical industry.

Dr Milton S W Lum – Fellow of the Royal College of Obstetricians and Gynaecologists, Academy of Medicine and the Royal Society of Medicine and a member of the Malaysian Medical Council.

Professor Dr Tariq Ramadan – Professor of Contemporary Islamic Studies at the Oxford University (Oriental Institute, St Antony’s College) and also teaches at the Oxford Faculty of Theology.

Datin Paduka Siti Sa’diah Sheikh Bakir – Corporate Advisor to the Managing Director of KPJ Healthcare Berhad after she served as Managing Director of KPJ Healthcare since March 1, 1993

All panelists were presented with the following question as the panel kicked off:

“Can clinical ethics be viewed in isolation to business ethics in the medical industry?”

Should the medical industry reorientate its views on clinical ethics from the perspective of the larger universal ethics?”

As the questions were answered, many arguments, as well as discourse and debate evolved on the sometimes taboo questions not only in Malaysia but also globally.

Some of the arguments and questions were as follows:

Role of economics in medical ethics – where are the lines drawn, who draws this line?

Oversight – Malaysian Medical Council – The judge, the jury the adjudicator – shouldn’t the chairman be elected and the council be independent? Should governments be involved in running healthcare business?

Politics and medicine – How much of national, local and organisational politics affect proper medical care to patients based on Hippocratic oath?

Profit versus service – Where are the lines drawn who monitors this?

Service versus KPI (waiting time etc) – In government hospitals – does one keep to KPI or good service?

Talent draining from public to private hospitals

Business and medical ethics – A fine line – The medical profession includes not only practising doctors and associations of doctors, but also the pharmaceutical industry, providing the drugs that are an essential component of modern medicine; the academic institutions and journals involved in training doctors and sponsoring essential research activities; and, the government granting agencies and other sponsors that supply essential funding to the research conducted by the medical profession

Where do the loyalty and ethical motivations lie?

Government regulations – government regulators: how to balance public health concerns vs economic footprint of an industry vs produces vs innovation?

Doctors owning businesses — How does one know if procedures done are not done to pay for new devices? How is this tracked?

Doctors maximising income – Confluence of interest between doctors and hospitals they work for ?

Insurance companies – How are these selected by hospitals – public and private. Would you drop insurance company that don’t pay patients well even though they may have been with hospital long? How are these decisions made?

Library of outcomes made public so that patients are able can select best options. Is it realistic? Who should manage? Where are the potential loopholes and gaps?

Drug and device business – Is the industry run by needs of patients or business of pharmacies and devices ? Role of doctors? Role of Hospital management? Role of politics?

Saving lives – drugs for HIV, meningitis, tuberculosis are expensive in poor countries? Shouldn’t the industry slash cost to save lives in these countries? Are they killing people by the costs?

Life support – at what point would you stop this – at the request of family and friends, at the request of hospital as its costing too much or when you think the patient will not make a recovery?

Organ transplants – How does the system ensures that this is ethically done and tracked? That organs are not given and transplanted based on whether someone is able to pay or not?

Hiding full outcomes and repercussions of diagnosis from patients? How does one monitor this?

Covering up mistakes – is it ethical to cover up mistakes of procedures and/or prescription if it is beneficial to patients?

Buying organs and national organs bank? – what’s legal and ethic?

I closed the panel with the following question to all panelists:

What is your biggest ethical dilemma in your areas of profession?

Ethics in the business of medicine and biosciences affects the rich and poor, the healthy and the unhealthy. It is therefore our moral duty if not obligation to continue this debate beyond this forum to the grass roots so that we each know that we have given honour to the life and health our Creator has bestowed on us.

On November 6, 2013, Malaysia’s largest private healthcare provider KPJ Healthcare hosted its annual medical convention in Kuala Lumpur. For the first time in the 12 years of the tenure of this convention, KPJ decided that it will open some of the debates that would traditionally revolve around medicine and clinical practices to the larger issues that affect the morality of doing business in any industry, not least the medical industry.

Dr Milton S W Lum – Fellow of the Royal College of Obstetricians and Gynaecologists, Academy of Medicine and the Royal Society of Medicine and a member of the Malaysian Medical Council.

Professor Dr Tariq Ramadan – Professor of Contemporary Islamic Studies at the Oxford University (Oriental Institute, St Antony’s College) and also teaches at the Oxford Faculty of Theology.

Datin Paduka Siti Sa’diah Sheikh Bakir – Corporate Advisor to the Managing Director of KPJ Healthcare Berhad after she served as Managing Director of KPJ Healthcare since March 1, 1993

All panelists were presented with the following question as the panel kicked off:

“Can clinical ethics be viewed in isolation to business ethics in the medical industry?”

Should the medical industry reorientate its views on clinical ethics from the perspective of the larger universal ethics?”

As the questions were answered, many arguments, as well as discourse and debate evolved on the sometimes taboo questions not only in Malaysia but also globally.

Some of the arguments and questions were as follows:

Role of economics in medical ethics – where are the lines drawn, who draws this line?

Oversight – Malaysian Medical Council – The judge, the jury the adjudicator – shouldn’t the chairman be elected and the council be independent? Should governments be involved in running healthcare business?

Politics and medicine – How much of national, local and organisational politics affect proper medical care to patients based on Hippocratic oath?

Profit versus service – Where are the lines drawn who monitors this?

Service versus KPI (waiting time etc) – In government hospitals – does one keep to KPI or good service?

Talent draining from public to private hospitals

Business and medical ethics – A fine line – The medical profession includes not only practising doctors and associations of doctors, but also the pharmaceutical industry, providing the drugs that are an essential component of modern medicine; the academic institutions and journals involved in training doctors and sponsoring essential research activities; and, the government granting agencies and other sponsors that supply essential funding to the research conducted by the medical profession

Where do the loyalty and ethical motivations lie?

Government regulations – government regulators: how to balance public health concerns vs economic footprint of an industry vs produces vs innovation?

Doctors owning businesses — How does one know if procedures done are not done to pay for new devices? How is this tracked?

Doctors maximising income – Confluence of interest between doctors and hospitals they work for ?

Insurance companies – How are these selected by hospitals – public and private. Would you drop insurance company that don’t pay patients well even though they may have been with hospital long? How are these decisions made?

Library of outcomes made public so that patients are able can select best options. Is it realistic? Who should manage? Where are the potential loopholes and gaps?

Drug and device business – Is the industry run by needs of patients or business of pharmacies and devices ? Role of doctors? Role of Hospital management? Role of politics?

Saving lives – drugs for HIV, meningitis, tuberculosis are expensive in poor countries? Shouldn’t the industry slash cost to save lives in these countries? Are they killing people by the costs?

Life support – at what point would you stop this – at the request of family and friends, at the request of hospital as its costing too much or when you think the patient will not make a recovery?

Organ transplants – How does the system ensures that this is ethically done and tracked? That organs are not given and transplanted based on whether someone is able to pay or not?

Hiding full outcomes and repercussions of diagnosis from patients? How does one monitor this?

Covering up mistakes – is it ethical to cover up mistakes of procedures and/or prescription if it is beneficial to patients?

Buying organs and national organs bank? – what’s legal and ethic?

I closed the panel with the following question to all panelists:

What is your biggest ethical dilemma in your areas of profession?

Ethics in the business of medicine and biosciences affects the rich and poor, the healthy and the unhealthy. It is therefore our moral duty if not obligation to continue this debate beyond this forum to the grass roots so that we each know that we have given honour to the life and health our Creator has bestowed on us.